George E. Yanulis, MEng, MS, Pascal Lim, MD, Ali Ahmad, MD, Zoran B

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Presentation transcript:

Coupled Pacing Reverses the Effects of Persistent Atrial Fibrillation on the Left Ventricle George E. Yanulis, MEng, MS, Pascal Lim, MD, Ali Ahmad, MD, Zoran B. Popović, MD, PhD, Don W. Wallick, PhD The Annals of Thoracic Surgery Volume 86, Issue 3, Pages 984-987 (September 2008) DOI: 10.1016/j.athoracsur.2008.03.085 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Concept of coupled pacing (CP) during atrial fibrillation (AF). A diagram illustrating the effects of applying coupled pacing to the right ventricle during AF. Note the CP results in atrioventricular nodal (AVN) block and the reduction in ventricular rate of mechanical contraction as illustrated by the spacing of the hearts. The Annals of Thoracic Surgery 2008 86, 984-987DOI: (10.1016/j.athoracsur.2008.03.085) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Hemodynamic tracings without coupled pacing (CP) (left panel, CP off) and then with CP (right panel, CP on) in a prior acute experiment. Marks above electrocardiogram (ECG) tracings illustrate ventricular rate of electrical activation, right ventricular (RV) electrogram, first derivative of left ventricular pressure (LVdp/dt). Marks above the left ventricular pressure (LV P) tracings illustrate ventricular rate of mechanical contraction, and marks above the aortic flow tracings illustrate ventricular rate of ejections. The Annals of Thoracic Surgery 2008 86, 984-987DOI: (10.1016/j.athoracsur.2008.03.085) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Electrocardiographic tracings of one dog taken during the three periods of this study. The top panel shows when the animal was in sinus rhythm. The number indicates the intrinsic electrical activations. The middle panel shows when the animal was in persistent atrial fibrillation (AF). The bottom panel shows coupled pacing (CP). The Annals of Thoracic Surgery 2008 86, 984-987DOI: (10.1016/j.athoracsur.2008.03.085) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 The effects of persistent atrial fibrillation (AF) and sustained coupled pacing (CP) on left ventricular ejection fraction and left ventricular rate of mechanical contraction (VRMC). The asterisk (*) indicates that persistent AF significantly changed both left ventricular ejection fraction (LVEF) and VRMC. The pound sign (#) indicates that sustained CP significantly reversed these prior changes within 3 to 4 weeks back toward their pre-AF values. (BL = baseline.) The Annals of Thoracic Surgery 2008 86, 984-987DOI: (10.1016/j.athoracsur.2008.03.085) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 The effects of persistent atrial fibrillation (AF) and sustained coupled pacing (CP) on left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and left atrial volume (LAV). The asterisk (*) indicates that persistent AF significantly increased LVEDV, LVESV, and LAV. The pound sign (#) indicates that sustained CP significantly reversed the AF-induced increases in LVEDV and LVESV. Although CP reduced LAV, this change did not reach statistical significance. The Annals of Thoracic Surgery 2008 86, 984-987DOI: (10.1016/j.athoracsur.2008.03.085) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions